FORM OF COUNTY REPORTS TO THE MEDICAL SOCIETY OF THE STATE OF PENNSYLVANIA.' I.-CAUSES WHICH MODIFY THE HEALTH OF THE COUNTY. 1. LOCALITY: Eoundaries of County, and its situation in the State. Its proximity to large rivers and the lakes; to mountain ranges; their direction and extent. 2. HYDIOGRAPHY OR DRAINAGE: Size and direction of watercourses, and of the dividing ridges, or water-sheds. Extent of river bottom. Power and rapidity of streams; danger and frequency of inun dition. Quantity of marshy or springy soil. Artificial water channels and reservoirs; amount of lockage. 3. TOPOGRAIHY: Area and mean altitude of County. Population and their lineage; chief avocations. Locationand size of principal towns. General character of surface; principal valleys and eminences. Nature aid extent of surface destitute of vegetation, tilled, coverd with forest, or in grass. Agricultual produce; kinds of timber; effects of clearing and of dranage on climate; extent of artificial irrigation. 4. GEOLOGY: Geological position, actual location, dip, direction, and extent of the different formations. Character o soil, subsoil, and subjacent rock. Source and lature of water used for domestic purposes. 5. METEOROLOGY: Latitude, longtude, and altitude of observer. I See printed Transations, vol. v. p. 52. 2 Inclose, by dotted lies with proper marginal references, those sections of the county in which epiderics have prevailed. 3 Observers for the Fanklin Institute, Philadelphia, as well as for the Smithsonian Institution, Wasington, reside in a number of the counties, and would furnish all the meteorobgical information required. See page 16, Part iii. 1858. Barometric, thermometric, and hygrometric states of the atmosphere for every day in the year, indicating, in columns, the amount in inches of rain, hail, and snow. 1. MORTALITY: II.-MORTUARY TABLES.' From fevers; from measles, smallpox, and varioloid. From diseases of the lungs and air-passages. From diseases of the nervous system. From diseases of the organs of nutrition. From diseases of the urino-genital organs. 2. CAUSES assigned for death where the number exceeds 10 per cent. of the whole. 3. QUARTERLY TABLES, showing the whole number of deaths of white and of colored persons under 1 year, from 1 to 2, from 2 to 5, from 5 to 10, from 10 to 15, from 15 to 20, and for every decennial period over 20. III. PREVALENT DISEASES.2 1. EPIDEMICS AND ENDEMICS OF THE YEAR: Their origin and march; apparently contagious or not; how affected by race, age, sex, temperament, avocation, circumfusa, ingesta, and the density of population. 2. FEVERS: Intermittent and remittent: their frequency ascompared with that of former years. Typhus and typhoid fevers; smallpox; benefits of vaccination; measles; scarlatina. 3. OTHER DISEASES: Observations on their etiology, pathology, anl therapeutics. Number of cases, and a comparison of it wth that of other 4. MISCELLANEOUS: Medical effects of indigenous plants, and ofnew remedies. Notices of members deceased during the year. List of officers and members. If, as is to be feared in many counties, the materias for this classification cannot be obtained, the reporter is requested to appro imate as closely to it as his means of information will admit. 2 In describing cases, give the age, sex, condition, and location of patient, season of year, treatment, and termination. REPORT OF THE ADAMS COUNTY MEDICAL SOCIETY. OUR Society has held the usual number of meetings during the year, all of which were moderately well attended, various subjects have been freely discussed, and cases of interest orally reported and commented upon. Locality, typography, geology of this county being well known, need no further description. No mortality tables are kept; the number of deaths during the year is believed to be below the usual average. No malarial diseases, nor any special epidemic, save of a mild form of diphtheria, which usually was promptly amenable to treatment. Scarlet fever prevailed in some localities to a considerable extent but no mortality in this county. In the adjoining county of Carroll, Md., many cases terminated fatally, as high as five deaths in a single family, some of whom were adults; these cases were in the hands of homœopathy. Pneumonitis and typhoid fever have prevailed to a less extent than usual, and in most cases where those diseases occurred the sanitary surroundings were good. Not a case of smallpox has been reported. Quite a number of cases of measles occurred, but of so mild a form that many did not need any physician. In obstetrical practice there have been no unusual phenomena, nor many cases of interest reported. One case of complete placenta prævia occurred, in which the hemorrhage during the last two weeks of gestation had been profuse, and in which the tampon was employed for four hours until sufficient dilation of os to allow the operation of turning. The child was stillborn. The mother recovered. I have but one communication for this report, viz., a case of typhlitis, with perforative ulceration of intestine, handed in by Dr. Elderdice, of McKnightstown, at the January 7th meeting, and, by vote of the Society, is inclosed with this report. WALTER H. O'NEAL, Secretary. Case of Typhlitis, with perforative Ulceration of Intestine.Patient, Mr. L. S., farmer, æt. 32, always enjoyed good health until 25th March, 1876, when he came under my care, suffering from a wellmarked attack of acute inflammation of cæcum, for which he was treated with large doses of opium, and freely blistered; making a good recovery, to all appearances, he being discharged as convalescent 4th April. The illness had followed exposure to cold and dampness, but could scarcely be considered to have been caused by it. During the summer he worked hard, and seemed in good health, except once, in July, he called at my office for medicine to relieve pain in his bowels. Was called in haste, at 6 P.M., 13th October, 1876, when found he had been ploughing all day previous, changing horses, and pushing his teams as fast as possible; had come home that evening chilled, and complaining of pain in abdomen, which continued, becoming more severe. When seen, he was suffering very severe pain in right inguinal region; whole abdomen tender under pressure; cold sweats; pulse 96, and weak; tongue clean; bowels constipated; prostrated and anxious. Diagnosed same complaint, for which I had treated him seven months previous, viz., inflammation of cæcum, or its vermiform appendix. Prescribed one-quarter gr. doses sulph. morph., to be taken every two, three, or four hours as needed, to subdue pain, and application of hot fomentations to the abdomen. October 14th. Patient improved, pain less, and paroxysmal; abdomen tender; no perceptible enlargement, nor any tympanites. Gave calomel grs. v, jalap grs. x, which operated freely. Followed it with opium gr.j, quiniæ gr. ss, every four hours. From this time to 20th continued same treatment, with a purgative enema, on alternate days, which acted promptly. Diet restricted to animal broth, milk, and soft-boiled eggs, with patient improving, and up and about his room. 20th. Severe pain, in paroxysms, resembling colic; abdomen tender, particularly over region of cæcum, and an oval tumor the size of a hen's egg, very perceptible to the touch, occupying the situation of the vermiform appendix. Continued the opium treatment, and applied a blister over right inguinal region. 24th. Tumor increasing in size; condition of patient much the same as 20th; costive, requiring enemas; pain paroxysmal; pulse 98; feverish; some tympanites; pain in penis, and difficulty in urinating. Same treatment continued, with addition of ol. terebinth. f3ss to the purgative enemas, and half ounce of whiskey, by the mouth, every four hours. 25th. Dr. R. Horner, of Gettysburg, called in consultation; condition of patient much the same as 24th, but less tympanites and less pain. Tongue furred, and red at tip and edges. Tumor now about size of a goose-egg, tender and painful. Pulse 100, with considerable fever present. It was decided to endeavor to open the bowels by a dose of castor oil, and continue the opium treatment, with the liquid nourishment and stimulants as before, and to paint surface over tumor with tinc. iodine until skin sore. The oil, a half ounce dose, operated nicely, and patient gradually improved, the treatment being continued, but reducing the doses of opium, and not requiring enemas until 31st. Nov. 4th. The phlegmonous tumor having suppurated, now opened into the bowels, discharging by the anus a considerable quantity of pus, and some little blood, for two days; the discharge only occurring when the bowels were spontaneously evacuated. 6th, 8th, 10th. Patient comfortable; bowels regular; pulse 86; tongue clean; appetite good; apparently convalescing; tumor reduced to less than one-third the size it was the 25th ult., but still 'hard and tender. 13th. Was called in haste at 1 A. M. Found patient suffering extremely severe pain in abdomen, bathed in a cold sweat, tossing about, and saying the pain would kill him if not quickly relieved. He was also, every few minutes, vomiting large quantities of thin, light yellow, frothy, stercoraceous matter, having an intensely fecal odor, and annoyed by paroxysms of distressing hiccough; complaining of intense thirst; pulse 110, weak; tongue red and dry; respiration hurried; temperature reduced. Sprinkled one-quarter grain sulph. morph. dry on tongue. It was at once rejected. Repeated it with same result. Then injected oneeighth grain morphia hypodermically in arm, which gave speedy relief to the pain, though vomiting continued at intervals, but not so frequently. He rested pretty well until 5 A. M. when pulse was 98; less thirst; bowels distinctly defined through abdominal walls; occasional vomiting of same fecal liquid, and pain again increasing in severity. Repeated hypodermic injection of one-eighth grain of morph. at 6 A. M., and ordered yellow of an egg beat up with milk one ounce, whiskey half ounce, to be injected into the rectum every four hours, and hot fomentations to the abdomen. At 3 P. M. (same day) Dr. Horner again saw the case with me. The pain was then less intense; vomiting had ceased; some nausea present; pulse 98; tongue red; abdomen somewhat tympanitic, but less so than before. Tumor same size as on the 10th. Abdomen not so tense as the night previous, but still presenting a feeling of |